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General NPI Number Information
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NPI Number | 1073585808
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Entity Type | Organization
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Legal Business Name | KIRBICORT, INC.
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Dates
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Enumeration Date | 02/06/2006
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Last Update Date | 03/21/2012
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Provider Practice Location Address
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Address Line | 2901 YULE CT
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City | CHRISTMAS
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State | FL
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Zip | 32709-8717
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Country | US
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Telephone | 407-568-6342
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Fax |
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Provider Business Mailing Address
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Address Line | 2455 CURRYVILLE RD
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City | OVIEDO
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State | FL
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Zip | 32766-9152
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Country | US
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Telephone | 407-971-8115
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Fax | 407-977-9458
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. MICHAEL G PRUNER
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Credential | RN
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Telephone | 407-971-8115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 7G343A-C
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License Number State | FL
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